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You have to be flexible to be in med-surg nursing
AMSN president says nurses are pros at handling change
By Janice Petrella Lynch, MSN, RN
Janice Petrella Lynch, MSN, RN, is director of the Help & Resource Center at The Marfan Foundation.
Experienced med-surg nurses know it takes a special kind of person to remain in the specialty because of the challenges that come with it, said Linda H. Yoder, PhD, MBA, RN, AOCN, FAAN, past-president of the Academy of Medical-Surgical Nurses, and a professor at the University of Texas at Austin School of Nursing. Yoder shared her thoughts on those challenges and how technology and evidence-based practice have improved patient care.
There are a number of different ways technology has played a part. For example, hand hygiene is an area in which most acute care teams struggle to meet compliance standards and are not performing it 100% of the time. New methods for monitoring staff members as they enter and exit rooms are now available and can track employees electronically with their
hand hygiene compliance
Institutions will no longer need to use “secret shoppers” for observations but can gather real time information on every patient encounter. This endeavor creates a safer environment for patients and employees and increases hand hygiene compliance. 
Another area where
technology use is expanding
is with the implementation of tablets and smart phones. Nurses are now using smart phones that interface with electronic health records and are able to scan medications, patient identification bracelets and document in real time. This technology is creating efficiency for nurses and giving them the ability to use the same device to answer calls and document care they have given. Patients are using tablets to communicate with nursing and physician teams, as well as input information into the admission database through the electronic medical record. The patients also can use the tablets as a distraction technique while they are in the hospital. Maintaining privacy of patient information and keeping electronic devices up to date and in working order is essential but challenging.
Med-surg nurses have multiple priorities because of the complexity of the patients they care for and therefore, it can be a challenge for the nurse to attend interprofessional huddles. It is important for nurse leaders to look at these processes to help clinical nurses attend these important conversations. 
Another challenge in the med-surg area can be the adoption of new technology. There is a wide spectrum of products, and nurses may or may not have a voice in what products for patient care or communication are purchased by a hospital or health system. Continually learning new products or computer documentation systems is a definite challenge. Electronic documentation itself has become a greater challenge for the med-surg nurse. It was originally intended to remove barriers and make documentation easier.

However, in many cases, nurses have to click through several screens to document something or to find needed information about the patient’s progression of care. Some nurses rely more on the EHR and less on direct communication with other nurses, for example, hand-offs; therefore, critical information may be missed.  Patients are admitted to acute care settings with multiple comorbidities and difficult social situations that test new and experienced nurses. This trend continues to stress med-surg nurses who juggle difficult patient loads and multiple admissions and discharges during each shift. Med-surg nurses in many hospitals are concerned about staffing shortages. Some of these problems are due to actual labor shortages in certain geographic areas. In other cases, the problem is created when administration uses older ways of determining staffing needs rather than acuity-based staffing.
In the last three years, an acute care medical center in Kansas City, Kan., has been using the Lean Management System (lean production,
Toyota Production System
to implement many performance improvement ideas and initiatives. This presents a large learning curve for the med-surg nurse because it completely changes how one looks at performance improvement. However, the constant
cycle creates evidence-based practice at the source. 
At the Kansas City medical center, med-surg nurses are involved in many different EBP projects that affect patient care. The majority of EBP projects involve nursing-specific indicators, such as fall prevention, pressure injury prevention and reduction in hospital-acquired infections from central line catheters or urinary catheters. Two projects currently in the implementation phase in an acute care medical center in Chicago are the use of turn teams for reduction in HAPI and proactive toileting for the prevention of falls. Both projects were initiated, researched and implemented by staff nurses within the shared governance setting. Each unit completes an EBP project yearly, which is run by the unit advisory council and is part of the shared governance system. This year the unit presented their project and findings on implementing turn teams in a hospital-wide quality day and won for best innovative safety project. This approach has been useful in involving front-line med-surg nurses in EBP and is supported by the organization, which is essential for EBP to be successful in the acute care setting.
AMSN believes evidence-based practice is a critical component of care provision in the med/surg setting. As healthcare becomes more complex and fragmented, EBP will become even more important for the future of healthcare and the profession. Nurses, along with other members of the healthcare team, can create practice guidelines that assist patients and families to transition back to their homes or other types of healthcare facilities.
AMSN has partnered with the Ohio State University and the Center for Transdisciplinary Evidence-based Practice to administer a survey to measure EBP practices among med-surg nurses. These results will be used to develop and operationalize EBP educational initiatives within AMSN, which will assist our members to better implement state-of-the-art practice.

AMSN and CTEP are also exploring the development of an EBP intensive for med-surg nurses that will be hands-on and immersive. AMSN has appointed its former president, Jill Arzouman, MS, RN, ACNS, BC, CMSRN, to lead initiatives related to EBP for the association. Chief nurse executives often state EBP is important but they also say once they fix quality and safety they will shift their focus to EBP. We hope to help CNEs recognize that improving quality and safety outcomes requires the use of EBP.
What are some of the challenges those who practice in the specialty face?
What is the position of the organization on new graduates taking positions in med-surg as their first practice position?
AMSN does not have a position that all nurses must work in med-surg in their first practice role. Based on a variety of needs in geographic areas across the U.S., many hospitals are accepting new graduates into pediatric and neonatal units, the ED and the OR. These hospitals then educate the new graduates in these specialties. However, working as a med-surg nurse for a couple of years certainly strengthens the clinical abilities for those who decide to move into critical care, nurse anesthesia or become a clinical nurse specialist. In addition, nurses who transition to primary care as clinic nurses or nurse practitioners benefit from a background in the specialty.
AMSN provides its members with continuing professional development through courses, its annual convention and its journal and newsletter, which contains high-quality peer-reviewed content, and through the dissemination of relevant practice research. To illustrate, AMSN currently has two research projects underway and a third that is about to launch. The first is a longitudinal study examining the impact of clinical leadership development on clinical nurses. The second study is the OSU EBP study that will explore EBP practices within med-surg units around the U.S.

Lastly, AMSN has a research study that is just about to launch that will examine the shared characteristics of AMSN PRISM award-winning units to inform best practices on med-surg units in the U.S. AMSN advocates on behalf of its members on topics of importance to med-surg nurses, such as healthy practice environments, staffing issues and the recognition of medical-surgical nursing as a specialty.
How do you foresee the future of EBP and/or research evolving in the specialty?  
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How has technology played a part in the med-surg practice area?
What evidence-based practices are med-surg nurses engaged in that improve patient care?
How do your members benefit from being part of AMSN?
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